Cancer patients are living longer due to improvements in health and more effective cancer therapies. As a result, they are at increased risk for late effects of their initial treatment. Estimating and disseminating information on these potential risks is important for ongoing post treatment surveillance by primary care providers and cancer specialists. To date, risks of short and long term effects of cancer treatment have mainly been estimated from clinical trials and single institution studies. This information may not be applicable to large segments of the population who are under represented in research protocols, such as older, minority and low income cancer patients and patients treated outside academic medical centers. We propose to focus on gynecologic cancers as a model system for studying late effects of radiation using the SEER Medicare Database. The overall objectives of this research are to 1) construct and evaluate claims based algorithms for defining late effects of radiation related to bowel and bladder toxicities, 2) estimate the risks of these effects among older cancer survivors diagnosed from 1986- 2002 and 3) examine variations in the risk by patient, physician and facility characteristics, Study findings have important implications for two groups of older adults with personal histories of cancer. For newly diagnosed patients, our risk estimates over the most recent follow-up period (2000-2005) are helpful for making decisions about current treatment options. Information over the entire study period can also be used to develop individual Survivorship Plans - tailored to the survivor's personal characteristics and when she was treated - with recommended follow-up care. Such plans are critical for the effective surveillance of cancer survivors by primary care physicians, who provide much of the long term follow-up care for patients with these adverse effects. The plans can also remind and encourage survivors to report symptoms related to potential toxicities. PUBLIC HEALTH RELEVANCE: This study will estimate population-based risks of late urinary and gastrointestinal toxicity among older survivors of gynecologic cancers. The information is important for the design of post treatment cancer surveillance programs. Estimates of late toxicities are also helpful for newly diagnosed patients, as they make decisions about their treatment options.